Abstract: In 2012, the US Preventive Service Task Force (USPTF), American Cancer Association (ACS), American Society for Colposcopy and Cervical Cytology (ASCCP), and American Society for Clinical Pathology (ASCP) updated the guidelines for cervical cancer screening with an unequivocal recommendation of screening NO MORE than once every 3 years. In their joint guidelines, the ACS, ASCCP, and ASCP actually recommend against annual screening. This shift in screening frequency represents a dramatic change from the past 50 years where annual screening was heavily encouraged. The new guidelines are the latest in a series of reports issued in recent years by medical and public health groups recommending fewer routine cancer screening because of emerging science showing that test intervals can be safely extended and doing so would reduce false-positive results, harm from unnecessary procedures, and improve cost-effectiveness of care. Evidence suggests that patients and providers alike are resistant to less frequent screening. While a great deal of research has been devoted to the promotion of screening tests, little is known about if and how the factors that influence behavior differ when the goal is less screening. The goal of this study is to examine the uptake of these recommendations in a large medical center and to explore patient-specific factors that explain attitudes and behaviors related to increased screening intervals in order to develop the appropriate education and/or other interventions to improve compliance with evidence- based guidelines. Our data structure enables us to look in increasing detail at both large-scale provider practices and individual women's attitudes and practices in regard to these guideline changes. Aim 1 will study the screening patterns of women seen in the Johns Hopkins Hospital (JHH) system. Aim 2 will investigate the correlates of acceptance of extended cervical cancer screening intervals among a sub-population of women seen at JHH. By meeting the proposed aims, we will provide a comprehensive assessment of screening practices at Johns Hopkins affiliated clinics and describe patient-specific characteristics that predict reluctance to adopt increased screening intervals. This information is needed in order to begin to develop appropriate intervention tools to improve compliance with evidence-based guidelines.